## TRANSMITTA Lof OMAH A LEA D SIT E SOI LREMEDIATIO N FIL EFOLDE R SA1D # 

# 1\00 ^ Date : Jl?H_2(_U ^ Addres s Remediatio n Contractor : _Coasta l Environmenta l Group

_Year ; _20 i 

# o e SOI LREMEDIATIO N PROPERT Y nLEFOLDE RDOCUMENT S Vide o o f property (DVD ) ^ Executiv e Summar y EPA-provide dproperty sketch ^ 

### SignedAcces; s Agreement fo r subject propert y -JZ LSignedAcces s Agreement(s ) fo r adjacen t propert y t

/ Restoratio n Agreement -B
- Settlement document s (i.e. , fo r damag e o r to replac e plants , etc. ) -B
- Confirmation dat a



# f /

Photograph s M^^nw^ i y i U (y=^>n> ^ P ^ As-built sketch u Satisfactor y restoratio n si^e db y Propert y Owner 1 2 Propert y close-ou t check lis t signe db y EP A .•B " Descriptio n o f area s no t meetin g RO D cleanup criteri a ^ 

### Utilit y clearance s PropertyJirfSf^atio n fro mDougla s Cbunt y Assessor' s Office [ J 

### D D __^_ ^ Signature I~ ~ TT T Dat e 3005478 5 

# inn m Superfun d• •


## Propert y Acces s Checklis t 1 Property ID : ?//)<-) « Property Addre.,:^^^ ! yr^Ci^^r ^ . D DWOR K STARTE D WOR K COMPELTED ON : ON : / / _/ / 

## o^"*'- ^ J3:^r.v^ ^ Addrcn : 

## Uer/iAwk y Rente r Phone : Pax : 

## Phone : z^oz . Fax : 

## (o^.yqQO i Cell/Pager . Additional Infomiation : Cell/Pager . 1, D ^ J ^ D O O J H ^ a | D D ^ D Notificatio n Lette r

Acces s Agreement

Restonttio n Agreemen t Topml i Samplin g (i f applicable ) Disposa l Samplhi g (I f applicable ) Gnrdc n Samplin g (if applicable ) Utilit y Clearanc e Video/Photo s (Before ) Video/Pboto s (During ) Video/Photo s (After) Video/Photo s (30-Day ) Propert y Completio n Agreement Final Report Sent : / / Signed : JQ_/13^<3 1 

## Signed:\a./\i/D B / / / / / / Called:iil/llo./C: Q



### On:JlljtilM On : / / On : / / On : / / Signed ; / / / ^ I 0 ^ Issued : / / By : By : By : By : By : By : 

## By : ]C)l70jc A By : [y^\(\\J\ 0 By : By : By : By : By ; Ai r Monitorin e (a s applicabl e D Communit y DCrc w Results : On : . / / By : 

# 1 D Commnnit y Results : D Cre w On : / / By ; Q Communit y Results : DCre w On : / / By :

Omah a Lea d Sit e

### • • 

## Dougla s Coimt y Accoim t In

t^|i|atio n 

## Pag e 1 of 3 Dougla s County , Nebrask a Propert yRecor d - R123648000 0 Prin t Repor t NE W Faatur e - Parce l Dimension s avaiiabi e 0 ) scai e 0-5 0 ft wes t o f 52n d S t - VlB W O H Ma p Infonnatio n i s vali d a s o f 2009-9-2 9 Treasurer' s Ta xRepor t Ne wFeatur e ^ • * -* Aut o Sale s Searc h Owne r HERNANDE Z ROCI O 321 7 PACIFI C S T OMAH AN E 68105-000 0 Propert yInformatio n Ke yNumber : 364 8 000 0 1 2 Accoun t Type : Residentia l Parce l Number : 123648000 0 Parce l Address : 321 7 PACIFI C S T OMAH AN E 68105-000 0 Lega l Description : HANSCO M PLAC E LO T2 4 BLOC K7 W 4 0 E 5 0 F TLT S 23 & 4 0 X 10 0 Valu e Informatio n Lan d Improvemen t Tota l 200 9 $5,200.0 0 $73,400.0 0 $78,600.0 0 200 8 $5,200.0 0 $73,400.0 0 $78,600.0 0 200 7 $5,200.0 0 $73,400.0 0 $78,600.0 0 200 6 $5,200.0 0 $48,500.0 0 $53,700.0 0 200 5 $5,200.0 0 $48,500.0 0 $53,700.0 0 200 4 $5,200.0 0 $48,500.0 0 $53,700.0 0 Sale s Informatio n Sale s Date : 2005-08-3 0 Dee d Type : W D Book : 200 5 Page : 11232 8 Price : $80,000.0 0 Grantor : MICHAE L AFAILLA Grantee : ROCI O HERNANDE Z Valld/lnvalld : Vali d Exclusio n Reason : Sale s Date : 2004-08-0 7 Dee d Type : W D Book : 200 4 Page : 13468 9 Price : $55,000.0 0 Grantor : H . R . SCHUETTETA L 

## http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.. . 10/13/2009

### Dougla s County Accoun t I :

t^unja||do n 

### Pag e 2 of 3 • • Grantee : MICHAE L AFAILL A Valid/Invalid : \ vali d Exclusio n Reason : Sale s Date : 1993-05-0 7 Dee d Type : D Book : 195 0 Page : \ 59 0 Price : \ $27,000.0 0 Grantor : Grantee : Valid/Invalid : Vali d Exclusio n Reason : Lan d Informatio n Acre s S F Unit s Dept h Widt h Vacan t 0.0 9 4000. 0 1. 0 100. 0 40. 0 No Improvement Informatio n Buildin g 1 

### TW O STOR Y
wo a r13 0 Iff 1 0

9kin f anki n CLIC KTO EI^LARG E IMAG E Squar e Footage : 1554. 0 Percen t Complete : 100.0 % Perimete r 0. 0 Quality : Averag e Uni t Type : Condition : Goo d

Buil t As : 2 Stor y Cond o Squar e Footage : 0. 0

HVAC : Centra l Ai rt o Ai r Rooms : 8. 0 Exterior : Fram e Sidin g Units : 1. 0 Interior : i Drywal l Baths : ! 1. 0 Roo f Cover : Compositio n Shingl e Bedrooms : 1 3. 0

Roo f Type : Gabl e Stories : 2. 0 Floorcover : Allowanc e Foundation : Bloc k 

### http://douglasne.mapping-online.com/DouglasCoNe/static/accountinfo.jsp?accountno=Rl. . . 10/13/200 9• • 

## Oougla s Count y Accoun t I

; r^^a||io n Pag e 3 of 3 Sprinkle rSquar e Footage : 0. 0 yearBu// f 189 5 Detai l Typ e Applianc e Basemen t Fixtur e Fixtur e Garag e Porci i Porc h Porc h yea r Remodele d 0 Percen t Remodele d 0 % Detai l Descriptio n Allowanc e Bsmn t Bloc k 8 ft Bas e Fixture s Bat h Ful l Detache d En d Soli d Wal l Sla b Roo f Cei l Sla b Roo f Cei l Adjuste d Yea r Physica l Ag e Buil t 189 5 11 3 Unit s 1. 0 651. 0 1. 0 1. 0 280. 0

40. 0 16. 0 155. 0



## http://douglasne.mapping-online.coin/DouglasCoNe/static/accountinfo.jsp?accountno=Rl.. . 10/13/2009

## Propert y I D # Propert y Address : Initial Contact : Secon dContact : Fina l Contact : Fina l Action :

Comment : Owner Comment (s) : Sit e Coordinato r Comment (s) : CONTACT FOR M 2.\0^ %



# ^ 7 \ 1 Vac\<nc-,S ^ Date : Time : Action :

Date : Time : Action ; Date : Time : Action : Transmi t t

o EP A D Other Action : DPag e 1 of 2

" > Creat e Anothe rTicke t Bac k t o Irt h Interne t ^^Sen d Ema H j; j



### • YOURTICKE T NUMBE RI S 2387861 . Origina l Cal l Date : 10/16/0 9 Time : 10:1 9 a m Op : ELIZABETH1879 0 Wor k t o Begi n Date : 10/20/0 9 Time : 10:4 5 a m State : N E County : DOUGLA S Place : OMAH A Address : 321 7 Street : PACIFI C S T Twp : 15 NRng : 13 E Sect-Qtr : 21-SW,28-N W Twp : Rng : Sect-Qtr : Lega l Given : C Typ e o f Work : LEA D REMEDIATIO N Locatio n o f Work : INCLUD E AL L EASEMENT S LOCAT E ENTIR E PROPERT Y Remarks : FA X AL L CLEAR S TO : (877)662-421 1 : UNSUR E O F CORNE R LO T Compan y: COASTA L ENVIRONMENTA L SERVIC E Contac t Name : ELIZABET H Phone : (877)662-421 0 Wor k Bein g Don e For : COASTA L Dept h o f Excavation : 4 F T Come r Lot : N Front : Y Rear : Y Involve s Tunnelin g o r Horizonta l Borin g N Explosives : N CXCAT V LEVEL 3 MUDO l MUD0 2 OMAHACO F 0PPDGPR 5 0PPDGPR 6 QLNNEI C QLNNEI F

Servic e Are a Contac t Phon e Number UtiUt y Typ e CXCAT V CO X COMMUNICATIONS , IN C HEIDI Day : 402934046 9 Alt : 402934046 9 Emerg : 402932975 7
LEVEL S LEVEL S COMMUNICATIONS , LL C N A Day : 877366834 4 Alt : 

### Emerg : 877366834 4
MUDO l METROPOLITA N UTILITIES DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0
MUD0 2 METROPOLITA N UTILITIES DISTRIC T SAND Y 

### Day : 402504782 3 Alt : Emerg : 402504797 0
http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/16/200 9

### Pag e 2 of 2

OMAHACO FCIT Y O FOMAHA-TRAFFIC,SEWE R 

### RICH/TRAFFI C Day : 402444719 7

Alt : 402444516 1 Emerg : 402444516 0
0PPDGPR 5 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3
OPPDGPR 6 OMAH A PUBLI C POWE RDISTRIC T N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI C QWES T LOCALNETWOR K N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3 QLNNEI FQWES T LOCA LNETWOR K N A 

### Day : 406728934 3 Alt : 406207149 4 Emerg : 888728934 3

http://www.dhon.org/irthintemet/DHONNoticeCreation/MessageText.asp?ret=<RESULT. . . 10/16/200 9

### 2100 8 OLS# : 2100 8 Dat e Excavated : 10/28/0 9 

# As-Buil t Drawin g Dat e USEP ASigne d Off : 11/10/0 9 C OASTA L Are a Sodden : 119 7 s o f t ENVmONMENTA L 

# Omah aLea dSuperfun dSit e C I I O U P , INC .

Omah a Lea d Sit e Owne rName : H R SCHUET T Sit e Sketc h

Omah al,eadSite 4613 0
Legen d Concre't e Dri p Zon e Excavate d Quadrant s Excavate d Are areplace dwit hAre areplace dwit h Are a lef t bar e So dRock/Mulc h Contrac t # : EP-R7-07-0 5 Coasta l Environmenta l Grou p Inc .% 

## 21001 8 

# CM. 1 2,q)T 6 f n admc £ Omah a Lea d Sit e Exterio rPain t Nortf i Am)w Owne rName : H R SCHUET T 

### • Goo d Sit e Sketc h Address : 321 7 PACIFI C S T D Pop f 

### Phone : .H - ( ^ '2/i- ^ W : Q^o t pain t 

# \ k Lea d Sampl e Sample s Collecte d Sampl e Numbe r LA B Concentratio n Collecte d Firm : \ - E - /VC T^•^•.k ' RYASCPXA-2100 8 F 1 pp m 

## D Date : ^ H -iL'^ l •q RYBSCPXA-2100 8 F 2 

### Q : '<^'~A ^ 

# riff l pp m Time : 

# n RYCSCPXA-2100 8 B l 

# 1 ^ JO . pp m Sample s Analyze d RYDSCPXA-2100 8 B 2 pp m 

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# n Date : 

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## D 

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# I Lea d Sampl e Sample s Collecte d Sampl e Numtw r 

# m . LA B Concentratio n Collecte d Fimi : S.E - fC T ^•A»A. . RYASCPXA-2100 8 F 1 pp m 

### D Date : _S.-^L'^ M RYBSCPXA-2100 8 F2 

### D I ppm Time : RYCSCPXA-2100 8 B 1 

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## :fAc;J?; ( s r Omah aLea dSit e 4613 0

### ( # COASTA l (NVIItONHIItTA t ' ^ i PHO^ ^ cK0 u rIN C 

## Consen t fo rAcces s T o Propeft y RIGH TO F ENTR YT O PREMISE S 

### Granto r(th e propertyowner) consent s t o an d authorize s th e Unite d State s Environmenta l Protectio n Agenc y(EPA) o rit s authorize d representatives , collectivel y th e Grantee , t o ente ran d perfor m certai n environmenta l respons e activitie s upo n th e followin g describe d premises : ^

Owner' s Name : Daytim e Phone :

Addres s o f Propert y covere d b ythi s Agreement : 

# ^7. . n PURPOS E O F RESPONS E ACTIVITIE S 

### Th e EPAi s requestin g acces s t o collect soi l sample s an d remove soi l tha t contain s elevate d concentration s o f lea d an d maypos e a healt h hazard . Th e area(s ) wil l b e excavate d t o remov e contaminate d soil . Th e remove d contaminate d soi l wil l b e replace d wit h clea n material s an d th e are a wil l b e restore d t o It s origina l condition . Thi s wor k i s bein g performe d unde rth e Omah a Lea d Superfun d Sit e remediatio n program . Arepresentativ e o f Coasta l Environmenta l Group , contracte d b yUSEPA , wil l contact th e Granto rin-perso n t o discus s th e wor k t o b e perfonned , th e Granto rwil l hav e a n opportunityt o revie wan d approv e th e planne d soi l removal , an d restoratio n wor k befor e i t begins . Onc e th e wor k i s finished , th e Granto rwil l b e aske d t o revie wth e wor k an d confir m tha t i t i s complet e an d meet s wit h th e Grantor' s approval . Upo n completion , th e Granto rwil l receiv e v^rritte n documentatio n fro m EPAtha t th e property has bee n remediated . ENVIRONMENTA L RESPONS E ACTION S 

### B

ysignin g thi s Acces s Agreement , th e Granto ri s grantin g th e EPA , it s employees , contractors an d subcontractors th e righ t t o ente rth e property , a t al l reasonabl e time s an d wit h prio rnotice , fo rth e sol e purpos e o f performin g th e work . Thi s acces s shal l remai n i n effect unti l th e wor k ha s bee n satisfactoril ycompleted . Th e Granto rals o agree s to :
Pag e 1 o f 2

## %

8 : » f 

### \ COASTA L tNVIRONHfKTA L C H O U ^ i h C 

### « Remov e obstruction s includin g boats , trailers , vehicles , playscap e items , woo d piles , do g houses , etc ; cRemov e flowe rbulb s o rplant s tha t th e Granto ro rth e Grantor' s tenan t maywis h t o save ; a Wate ran d maintai n replacemen t vegetation , includin g fertilize rapplication , a s necessar ysubsequen t t o a n initia l waterin g perio d byEPA ; cAbid e b yhealt h an d safetyguidanc e provide d b yEPA ; « I f th e propertyI s rented , assis t EPAi n obtainin g tenan t approva l fo racces s t o th e propertyt o perfor m th e work . cAllo wvideotapin g and/o rphotographin g o f th e property . AGREEMEN TNO TT o INTERFER E 

### Th e Granto ragree s no t t o interfer e o rtampe rwit h an yo f th e wor k activities , o rwit h an y o f th e wor k done , o rwit h th e equipmen t use d o n hi s property , o rt o undertak e an y action s regardin g th e us e o f sai d propertywhic h woul d ten d t o endange rth e healt h o r welfar e o f th e Grantee s o rth e environment , o rt o allo wother s t o us e th e propert yi n suc h a manner . Shoul d yo u hav e an yquestion s abou t thi s program , pleas e contact Coasta l Environmenta l Group , a t (402 ) 991-119 9 I gran t acces s t o m yproperties D i d o no t grant acces s t o m ypropertie s
Signatur e Dat e Signatur e Dat e
D I woul d lik e t o b e presen t durin g an ysamplin g tha t i s required .

Pag e 2 o f 2,^_ . t» T COASTA L 

## Restoratao n Agreemen t Th e purpos e of thi s agreemen i is to provide amutua l agreemen t as to condition s of th e properly prior to remediatio n activities . Thi s will als o serv e as documentation fo r th e purpos e of assuring tha t restoratio n activitie s ar e completedto th e satisfactio n of th e propert y owne r andthe UnitedState s Environmenta l Protectio n Agenc y (EPA) . Propert y ID : 

# ^\c W \Propert y Address Address 

### : ^^ ^^. O 

### ^acfe . n \ 

### ^ Phone : jp^C ^ - ^.^^ l On th e attacheddiagram(s ) indicat e area(s )to excavate , surface structure s an dlandscaping feature s an d acces s location(s )to be used by th e contractors . Indicat e distances , depths , materia l types , etc . Photographically an dVideographicall y documen t th e existing condition s ofth e propert y an dthe basemen t if necessary . Item s tobe Remove d byth e Owne rbefor e Star t of Remediation : Th e (emoval . storage , disposal , and/o rretur n of theseJtom s is th e Owner' s responsibility . 

# ^^ ftng ^t^, U t)(Qn b ^ Vy w^ ^

ttem: Item :



### Item s to be Remove d byth e Contracto rDurin g Remediatio n an d No t Repla<» d Item :



### Item : Item :

Pag e 1 o f /:^" ^ C OASTA L 

### Item s t o B e Remove dB y Contracto r Durin g Remediation_aridgegilaced _ Item : 

# ^5>C>'^ 1 C^i^^ ^ ^fo^.^z..^^ . Itenrit N I Item : »



### Landscap e Inventor y Ite m Pre-existin g propert y area , ^ tha t will b e excavated , tha t i s covere dwit hgrass . Numbe r of tree s > 2 inc h trun k

diamete r Numbe r o f tree s < = 2 inc h trun k

diamete r Numbe r o f Sprinkle r Zones , Control Valves , Timers , Heads , etc . Miat h; i skeicl i o l tlii ? '.('I'l-'klo i lin-.m ; Numbe r o f andsiz e of eachgarden / flower be d area . Aiuitj i i l sk^.'icl i 1) 1 ri-lniiv f >i/i- S an dlociiiii'i K Agreedupo n valu e of plan t material s no t to b e rcpjace db y contractor . Vcl c l!"ii ' M-ilii c mi l n t i;ii'c : K l Is ; Ul . 1 OIHII ! >nin.'>if : l<. ' ili f nrcipci'l N II M fiijr . Easemen t Area , to b e excavated 

### Quantit y 

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# I 

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^ Unit Condition/Type/Specie s Quadrants 

# ^ H V^^

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# "^tmaiino . ^£3L>\+5 . Pag e 2 . ^COASTA L
! Additiona l Comment s / Instructions : j 

# i ^pDnr V^^i' o Pnay^^ e Trees , h^isr^i ^ o v La-nd'^cape
- Are aooHlne . ir v Map A 

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# L . Q Chec k th e t}o xi f Owne rdoe s no t wan t CE G t o documen t interio rfoundatio n walls an d possibl e pre-«xistin g damage . B ycheckin g thi s bo xCE G i s no t responsible fo ran ydamag e don e t o th e interio ro f house , includin g foundatio n crack s o rfissures .



### agre e Q I do no t agre e 

# X" '

Owner' s Signatur e fi^^^ contractor' s Signatur e / Dat e ' 

### Pag e 3 o f /

### BVI D 

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## iiJJL \ Omah a Lea d Site—Fixe d Pric e EP-R7-07-0 5 I ^^^2 ^

o Coasta l Environmenta l Grou p Inc . ^^^^ ^ V"^^! ^

www.coastalhazmat.co m '"^^^ ^ VpHott ^ COASTA L INVItOHNIIITA l Clo u P . IN C 

# EXECUTIV ESUMMARY : BVID #21008-(321 7 PACIFI C ST ) No Issue s o r Concern s [] ] Issues/Concern s Detail Explanation :^ ^ 

### CMIJF ^ 

# EP A Propert y Clos e Ou t For m 

# J> t Propert y # : O^IDOK . Propert yAddress : Date/Time : Owacr* s Name: . ^ Quad s Ewavattd : |5» , ^ g . [> ^ Contracto rGrou p Ye s N o Excavatio B Genen i ( ^ ' 1 .If necessaiy , were th e come t quadnuit(s ) excavate dan drestored ? 2 .If necessary , were th e correc t area s ofdri p zone excavate dandrestored ? Ye s N o Gradin g So d an d Vegelatio a I .Doe s di e gradin g aroun dth e perimeter ofth e hous e i n excavate darea s generall y slop e awa y 

### C^ ' fromth e house ? 2 .Ha s so dbee n lai din al l area s tha t wer e excavated ? 3 .Doe s th e sodappear t o b e generally healthy an dgrowing ? (Onl y evaluate if inspecte da t a3 0 da y time period ) 4 .Ar e soddedarea s generall y fir man devenly graded ? 5 .

Ar e th e joint s betwee n th e so dstrip s generally tight ? (Only evaluate if inspecte da t a3 0 da y 

# T ; ^ tim e period) 

# z:^ ' 6 .Wa s the propert y grade dsuchtha t wate r wil l no t poo l o n th e propert>' ? c ^ 7 .Wa s danug e t o landscapin g o r plan t material s avoided ? Gates , Fence s an d Retainln t Wal b Ve s N o 1 •D o gate s ope n an dclos e freely? (If applicable ) 2 .Wer e all gate s or fence s taken dow n durin g restoratio n activitie s reinstalled ? (Ifappiicable ) 

### Lx- ^ 3 .Wa s damage t o gate s o r fence s avoided ? (Ifappiicable ) 4 .Wa s damag e t o retainin g wall s avoided ? (Ifappiicable ) Foundation , SidinKan dGutter s Ye s N o I .Wa s damage t o th e sidin g o r tri mavoided ? 

# U " 2 . Wa s damag e t o th e foundatio n avoided ? 

# I^ ^ 3 .

Wa s damag e t o window s avoided ? 

### \y ^ 4 .Wa s damag e t o window s or doo r screen s avoided ? i^ " S .Wa s damag e t o downspout s or downspou t extension s avoided ? Sidewalk s an d Driveway s (Concrete ) Ye s N o I .Wa s damag e t o driveway surface s avoided ? 

# y 2 .Wa s damage t o walkwa y surface s avoided ? ^ '^ 

## Owner s comments :

Inspectio n notes :

Remova l an drestoratio n activate s complete including the 30-da y so dwarranty : EP A Representativ e LJcP n \^a/^^iAyfijL^. ^ Date : \\\f ^ j ^ j

## Propert yCompletio n Agreemen t ihi s agreemen t documeni s lh e compielion ol remedia l acliviiie s perioimed on my properl y

My signatur e wil l designate llia l I amsatisfiedwil hlh e rcstoralio n of my propeily , an dIha l no items ar e in question s MOW , or at an y tim e in th e fiiture, excep t thos e ilems liste dbelow , ifany Property m: 21 ^^g ^ Property Address : 5^) ^ FQuflY , ;>V . Owner : \2t^',C ^ Wtmof^le ^ 

## -""" " • YX n o n ^tfn o rwj i Phone:^L|Q2.;^„^q-Zgg Q Restoratio n Item s in Question :

Item : Item : Item ; Item : Item : Item :

P^J'^fll'rc cI'Citarolio n i. < complcttd , excep t as noter i [ I I do no l ii|;rc crcjttorntin n is complele d

Owner' s Signatur e Lnat cGontrarlor' Si g Dal e Contrarlor' s Signatur e